P0104 UNICEF Infant and Young Child Feeding

This activity is has USG Team Botswana Internal Reference Number P0104. This activity links to the following: C0613 & C0615 & C0802 & P0102 & P0105 & P0106 & P0107 & P0108 & T1101 & T1111 & T1114.

FY07 funding will continue to support activities that were initiated in FY05 and FY06, including strengthening linkages between the PMTCT and ARV treatment programs, and implementing the infant and young child feeding and child survival interventions. The assessment of barriers to access to services for HIV-infected pregnant women will be completed during the beginning of FY07. This assessment will identify structural and organizational bottlenecks that hinder women, their partners, and children to access services, particularly access to ART and opportunities for early HIV diagnosis for children. These issues will be addressed in 2007. The outbreak of diarrhea associated with acute severe malnutrition that occurred among children between November 2005 and April 2006 further emphasized the need to increase efforts to address infant and young child feeding issues and personal hygiene through the UNICEF/EP collaboration. Over 35,000 children were affected during the diarrhea outbreak, and 530 children died; most of these children were not breastfed. A study conducted by HHS/CDC in Francistown during this period followed 154 children admitted into the hospital, and showed that 43% of the children had prolonged diarrhea and had been discharged and readmitted at least once during the study. Many of these children developed severe acute malnutrition during or after diarrhea; 42% developed marasmus, and 20% developed kwashiorkor. In addition, most were growing poorly before the onset of diarrhea, and were not being adequately managed despite monthly weighing at clinics. A high mortality of 21% (32/154) was recorded among these children.

Key lessons learned from the outbreak include the importance of continuing to strengthen the promotion of breast feeding among HIV-negative women, and the need to more closely monitor children who are on infant formula. For those children on formula feeding, there is a need to ensure availability of safe, clean water, and to consider scaling up the use of cup feeding instead of bottle feeding. USG will advocate that a consultative meeting of stakeholders is held in FY07 to review polices and guidelines to help map out interventions for HIV positive women who are exclusively breastfeeding, have high CD4 counts, or take ART and who normally have a low risk of HIV transmission. Another lesson learned was the importance of growth monitoring and follow up of infants and young children. In FY07, training will continue to be provided for health staff on the management of diarrhea and malnutrition, as well as promotion of hand washing with soap. During 2006, UNICEF supported the assessment of the Botswana National Nutrition Surveillance system (BNNS), which is based on the child welfare card. FY07 funds will be set aside to support the recommendations from this assessment which are to strengthen the system in terms of data collection and analysis, as well as improve the capacity of health workers to utilize the information that is collected.

Areas of focus for 2007 include the following: •Implementation of recommendations from the national consultative meeting on policy and programmatic issues related to Infant and Young Child Feeding (IYCF), such as revising of national guidelines as appropriate, and strengthening child growth monitoring, especially for children on formula feeding, using revised child welfare cards. •Provision of technical assistance to the MOH to strengthen and support the implementation of infant and young child feeding and growth monitoring. •Training for health workers on safe infant feeding and management of malnutrition.

06-P0225: UNICEF

This activity is continuing in FY07, with no additional funds requested.

This activity is a needs assessment, in that it provides assistance to a program aimed at mapping youth HIV/AIDS prevention and other activities, to inform future program planning and coordination. The assessment will target community-based organizations, faith-based organizations, non-governmental organizations, and host country government workers.

This activity intends to strengthen coordination and collaboration of youth activities by providing a map of existing community-level services for youth across the country. With such an inventory, all partners in youth activities (donors, government, civil society) will be able to better identify gaps in terms of geography, partner types, funding, and program types and in turn adjust future plans accordingly and communicate with local partners more efficiently. Activities in government, civil sector, and private sector from across the country will be included in the assessment to the extent possible. Funding will help cover the costs of travel, salaries of assessment interviewers, write-up, and dissemination of the mapping exercise.

Though Botswana has a small population, its large size and other issues hamper effective coordination of HIV prevention activities in a number of areas, including those targeting youth. Strengthening the government of Botswana's ability to coordinate youth activities supports USG goals to better support youth initiatives as well as government's and other donors' capacities to program effectively and efficiently.

Per FY 2007 July reprogramming activity sheet;These funds will further strengthen and support the Technical Assistance provided to the Government of Botswana and other active OVC stakeholders. The funds will support DSS to establish and strengthen its coordinating structures both at the national and district level and though a partner will no longer provide the support, HHS/CDC technical officers will strengthen their supportive activities.

07-C0812: UNICEF: Technical support to the MLG.

This activity has USG Team Botswana Internal Reference Number C0812. This activity links to the following: C0613 & C0802 & C0803 & C0811 & C0815 & CO811 & T1101.

Since 2004, EP and UNICEF have had a collaborative agreement to support the national orphan care program by providing direct support through assistance to 8 NGOs/CBOs. The 2004 funds were used to support feeding programs, psycho-social support activities, learning materials, play equipment, vehicles, volunteer allowances and office equipment to enhance program level implementation. Training was provided in financial management and reporting.

In FY05 EP funding was utilized to strengthen OVC community-based organizations and extend the services to 4 additional organizations. EP support enabled UNICEF to reach approximately 8,000 OVC with basic services.

The Mid-Term Review (MTR) of the 2003-2007 Government of Botswana/UNICEF country program (2006) noted the relevance and effectiveness of the Orphan Care Program's STPA, being implemented by the DSS as it responded to unmet needs of orphaned children. The Orphan Care Program helped to strengthen capacity and service delivery gaps and helped generate additional financial resources. While progress towards realizing program objectives was noted, improvement was needed in the areas of partnership development and coordination, both within the national and program context.

FY06, UNICEF will be able to establish linkages with Marang Child Care Network and Peace Corps in order to facilitate better coordination and scaling up of services. This partnership will enhance monitoring activities and ensure that there is no duplication of services. UNICEF will use its comparative advantage and its access to international tools to support the members of the Network and link them with similar organizations in the region.

Based on the needs of DSS and the need to strengthen the coordination of OVC programs, in FY07 UNICEF will focus on assisting DSS and OVC-serving organizations (NGOs/CBOs/FBOs) to provide services to OVC by using a rights-based approach. Using funds from other sources of funding, UNICEF will support DSS to disseminate relevant legislation affecting orphans and vulnerable children to different stakeholders. UNICEF will also work closely with DSS and other relevant stakeholders in advocating for implementation of guidelines and other policy frameworks on OVC. All these activities aim to strengthen the coordination of OVC programs at both the national and district level

In FY07, UNICEF will support DSS to establish and strengthen its coordinating structures both at the national and district level to ensure comprehensive and effective delivery of services for orphans and vulnerable children. Some of these coordination structures will include the National Children's Council and District and Village Child Welfare Committees. UNICEF will also take a lead role in assisting DSS with National OVC Forums. These Forums will be held annually and will bring together NGOs/CBOs/FBOs and other relevant stakeholders to share best practices and lessons learned in OVC programming.

Further, in FY07, UNICEF will utilize funds from other donors to continue building the capacity of the NGOs/CBOs/FBOs that it has been supporting with USG funds in FY04/05/06. The support will include giving these community organizations grants for OVC services, including support for the organizations to provide psychosocial support and other basic needs.

UNICEF will collaborate with DSS and other OVC-serving organizations to ensure quality provision of OVC services and that programs results are monitored and documented.